Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial.
Tech Coloproctol
; 18(11): 1081-5, 2014 Nov.
Article
em En
| MEDLINE
| ID: mdl-25248418
ABSTRACT
BACKGROUND:
A randomized controlled trial showed that patients with grade III or IV internal hemorrhoids had similar symptomatic relief of symptoms up to 3 months following dearterialization with mucopexy or hemorrhoidectomy albeit with less postoperative pain after the former. This study aimed to compare hemorrhoidal recurrence and chronic complications at 3-year follow-up.METHODS:
This study was carried out on 40 patients with grade III or IV internal hemorrhoids previously enrolled to a randomized trial comparing dearterialization to hemorrhoidectomy. Recurrence was defined as internal hemorrhoids diagnosed on proctoscopy. Chronic complications were nonresolving adverse events related to surgery. Outcome measures included patient-reported outcomes and quality of life measured by brief pain inventory (BPI), SF-12, and fecal incontinence surveys.RESULTS:
At median follow-up of 36 (27-43) months, 13 patients (32.5 %) were lost to follow-up. Patient-reported outcomes suggested no difference between dearterialization and hemorrhoidectomy in persistent symptoms, occurring in 1 (8.3 %) vs. 2 (13.3 %) patients (p = 0.681) and in symptom recurrence, occurring in 6 (50 %) vs. 4 (26.7 %) patients (p = 0.212). On proctoscopy, recurrence was seen in 2 (13.3 %) vs. 1 (6.7 %) patients (p = 0.411), all with index grade IV disease. One patient in each arm required reoperation (p = 0.869). Chronic complications were not seen in the dearterialization arm while they occurred in 2 (13.3 %) hemorrhoidectomy patients (p = 0.189) and included unhealed wound (n = 1), anal fissure (n = 1) and fecal incontinence (n = 1). There was a trend toward more patient reported than actual recurrence on proctoscopy (10 vs. 3, p = 0.259). There was no difference in BPI, SF-12, and fecal incontinence quality of life scores.CONCLUSIONS:
Recurrence rates did not differ significantly at 3-year follow-up and occurred in patients with index grade IV hemorrhoids. Chronic complications occurred only after hemorrhoidectomy.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Artérias
/
Reto
/
Hemorroidectomia
/
Hemorroidas
/
Mucosa Intestinal
Tipo de estudo:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
Limite:
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Tech Coloproctol
Assunto da revista:
GASTROENTEROLOGIA
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
Estados Unidos